Department of Vascular Surgery, University Hospital of RWTH Aachen, Pauwelsstr 30, 52074, Aachen, Germany.
Hernia. 2010 Dec;14(6):623-7. doi: 10.1007/s10029-010-0725-5. Epub 2010 Sep 12.
Reinforcement of the abdominal wall with alloplastic mesh material in incisional hernia repair is well established. To avoid dislocation and migration of the prostheses, mesh fixation is recommended. However, there seems to be a correlation between postoperative pain and mesh fixation. Furthermore, it remains unclear whether mesh fixation is necessary at all.
A retromuscular mesh implantation was performed in 36 pigs using a polypropylene-polyglecaprone 25 composite mesh (Ultrapro(®), 12 × 18 cm). In group 1, the mesh was fixed to the posterior rectus sheet with non absorbable single sutures (Prolene(®) 2-0), in group 2 fixation was with absorbable sutures (Vicryl(®) 2-0), in group 3 mesh fixation was with 5 ml fibrin sealant (Quixil(®)), and, as a control, there was no fixation in group 4. The abdominal wall was explanted on postoperative day 7, 14 and 56. Mesh size and position was measured, and pull-out force of the mesh was analysed mechanically by tensiometry. The ratio of collagen type I/III was analysed to determine the quality of mesh integration.
Neither mesh dislocation nor mesh migration was detected. Mesh size showed no significant differences, whether comparing time points or groups. No significant differences in the tensile strength of mesh integration were found when comparing the groups (group 1: 155 ± 17 mmHg; group 2: 175 ± 9 mmHg; group 3: 166 ± 24 mmHg; group 4: 172 ± 28 mmHg). Though the type I/III collagen ratio increased over time, no significant differences according to the type of fixation used were detected.
Mesh fixation in open incisional hernia repair with retromuscular mesh augmentation to avoid mesh dislocation or migration in the early postoperative period appears to be unnecessary.
在切口疝修补术中使用合成材料补片强化腹壁已得到广泛认可。为了防止假体移位和迁移，建议进行补片固定。然而，术后疼痛与补片固定之间似乎存在关联。此外，补片固定是否完全必要仍不清楚。
将一种聚丙稀-聚己内酯 25 复合补片（Ultrapro(®)，12×18cm）应用于 36 头猪的腹横筋膜后植入术。在第 1 组中，使用不可吸收单缝线（Prolene(®)2-0）将补片固定在后侧腹直肌筋膜上，在第 2 组中，使用可吸收缝线（Vicryl(®)2-0）进行固定，在第 3 组中，使用 5ml 纤维蛋白胶（Quixil(®)）进行固定，第 4 组作为对照组，不进行固定。术后第 7、14 和 56 天，取出腹壁。测量补片的大小和位置，并通过张力测试分析补片的拔出力。分析胶原 I/III 比值以确定补片整合的质量。
未发现补片移位或迁移。无论比较时间点还是组间，补片大小均无显著差异。各组间补片整合的拉伸强度无显著差异（第 1 组：155±17mmHg；第 2 组：175±9mmHg；第 3 组：166±24mmHg；第 4 组：172±28mmHg）。尽管 I/III 型胶原比值随时间增加，但未发现与固定类型相关的显著差异。
在开放式切口疝修补术中使用后入路补片增强，以避免术后早期补片移位或迁移，固定补片似乎是不必要的。
